Nuts or Normal??

The DSM5 Revisited.
          The Diagnostic and Statistical Manual of Mental Disorders updated in 2013 and published by the American Psychiatric Association serves as the American authority on  mental diagnosis.  It has a frightening influence on the lives of individuals with the  potential of labeling them for life, on the basis of clinical observations that often are subjectively interpreted and sometimes seem to have great difficulty in distinguishing between normal reactions to the stresses of life and actual mental illness. There seems to  be particular difficulty in dealing with what is to be considered a normal response to bereavement and in distinguishing it from a depressive disorder.  In the DSM4 psychiatrists are advised  not to  make a diagnosis of depression for at least two months after the death and then only in the  presence of some of the  more serious signs of depression.     The new edition removes this qualifier, thereby medicalising grief and making treatment with antidepressant or other drugs  more likely.  This in  itself  may not impair the grieving process. The suggestion  that avoiding  the diagnosis of depression in this situation, as a general rule may result in people who are profoundly depressed not receiving treatment, would imply that the physicians treating these persons are lacking any capacity to diverge from the cookbook recommendations that the DSM5 has become, in  favour of appropriate individual treatment.  Experience, knowledge of the patient and understanding seem  to be totally disregarded, with treatment recommendations increasingly veering to early introduction of drug therapy.  Unfortunately, insurance company coverage, government pensions and fee schedules appear to have an unseemly connection to diagnostic codes. Unlike the rest of medicine, in psychiatry, there are  no  diagnostic tests to confirm  or refute diagnosis.  There is a trend towards early (perhaps too early) diagnosis and drug treatment.  Perhaps the  'Choosing Wisely' Program needs to be applied in psychiatry as urgently as anywhere else.